Thousands of local residents can no longer use their insurance cards at Premier Health hospitals as a result of failed contract talks between the Dayton-based health system and one of its largest insurance carriers, UnitedHealthcare.
Premier’s contract to provide hospital coverage for UHC’s individual and commercial health plan members expired Saturday, denying UHC members in-network access to Miami Vally Hospital and Good Samaritan Hospital, among others in the Premier system.
Premier physicians will remain in-network through May 13 for employer-sponsored and individual plans. And Premier hospitals and physicians will continue to provide services to UHC members with Medicaid plans until May 13.
UHC members currently out of network at Premier hospitals have the option of seeking care and services at other hospitals that accept UHC plans, including hospitals in the Dayton-based Kettering Health Network, Dayton Children’s Hospital and Springfield Regional Medical Center.
Technically, UHC members with employer-sponsored and individual plans can still visit Premier hospitals, but they’ll be charged significantly higher rates than if the hospitals were still in their coverage networks, according to Scott McGohan, CEO at McGohan Brabender insurance brokers in Moraine. The firm represents about 1,200 area employers with nearly 100,000 employees, about half of whom have UnitedHealthcare plans, McGohan said.
“In an emergency situation, the public is protected,” he said, referring to provisions under The Affordable Care Act that require insurance companies to cover care for emergency medical conditions, regardless of ER’s network affiliation. “But when it comes to elective services, if you have UnitedHealthcare, and you use Premier hospitals, you could be balanced-billed, and that could cost you about double.”
Balance billing occurs when a hospital or another provider bills you for the difference between the provider’s charge and the maximum reimbursement rate for in-network plans. In network patients are not allowed to be balance-billed for covered services.
Overall, about 70,000 UnitedHealthcare members could be affected by the contract talks, which showed some progress on Friday when Premier and UHC agreed to extend their network relationship for Medicare Advantage plans through the end of this year.
But while both sides remain open to negotiations, each side blamed the other for the current and potential interruption in coverage for tens of thousands UHC members who visit Premier hospitals and physicians.
Premier said UHC denied its offer to extend their current contract until the end of this year, even though Premier was willing to forgo any increase in rates.
“We have been focused on how to best serve our patients and area employers during these negotiations with UnitedHealthcare,” said Mary Boosalis, president and CEO of Premier Health. “We put forth a proposal that included Premier Health forgoing a nominal rate increase. An agreement would have provided choice for our patients and area employers that we believe they deserve. We are extremely disappointed with the response from UnitedHealthcare, which disadvantages their enrollees.”
UHC blamed Premier for the contract impasse because of the hospital system’s unwillingness to be part of its tiered health plan design. Tiered plans rate doctors and hospitals based on the cost and quality of their care, and then charge consumer’s based on that rating. UHC said its tiered plan is designed to drive down health costs.
“As one of the most expensive health systems in Southwestern Ohio, Premier continues to make demands that would prevent employers from giving their workers incentives for choosing quality, cost efficient care providers and instead, insists on continuing to drive up costs for the community,” UHC said in a statement.
According to McGohan, the battle between Premier and UHC underscores a larger problem plaguing the Dayton area.
“This is really about the cost of health care in Dayton,” he said. “The cost of health care in Dayton is about 20 percent higher than it is in Cincinnati (on average). If we’re going to grow jobs and keep jobs in this community, we’ve got to make sure that our health care costs are competitive with Cincinnati and other cities.”